International Conference on Business & Economics

ICBE HOU

International Conference on Business & Economics HELLENIC OPEN UNIVERSITY

Hotel Titania APRIL 21, 2017 - APRIL 22, 2017

HELLENIC OPEN UNIVERSITY

Organizing Team Scientific Comittee

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Dr Christos Alexakis, University of Piraeus, Greece Dr Panagiotis Alexakis, National and Kapodistrian University of Athens, Greece Dr Vasilis Angelis, University of the Aegean, Greece Dr Dimitrios Asteriou, Hellenic Open University, Greece Dr Dimitrios Balios, National and Kapodistrian University of Athens Department of Economics, Greece Dr Apostolos Ballas, Athens University of Economics and Business, Greece Dr Yannis Charalabidis, University of the Aegean Dr Nikolaos Daskalakis, Brighton Business School, United Kingdom Dr Athina Dilmperi, Middlesex University, United Kingdom Dr Augustinos I. Dimitras, Hellenic Open University, Greece Dr Nikolaos Eriotis, National and Kapodistrian University of Athens, Greece Dr Grigorios Gikas, Technological Educational Institute of Epirus, Greece Dr Periklis Gogas, Democritus University of Thrace, Greece Dr Dimitrios Gounopoulos, University of Sussex, United Kingdom Dr Dimosthenis Hevas, Athens University of Economics and Business, Greece Dr Alina Hyz, Technological Educational Institute of Piraeus, Greece Dr Dimitris Ioannidis, University of Macedonia, Greece Dr Panagiotis Kaldis, Technological Educational Institute of Athens, Greece Dr John Kehagias, Hellenic Open University, Greece Dr Dimitris Kenourgios, National and Kapodistrian University of Athens, Greece Dr Kyriaki Kosmidou, Aristotle University of Thessaloniki, Greece Dr Christos Negakis, University of Macedonia, Greece Dr Chrissoleon Papadopoulos, Aristotle University of Thessaloniki, Greece

INTERNATIONAL CONFERENCE ON BUSINESS & ECONOMICS

ICBE HOU

Dr Christos Papazoglou, Panteion University of Social and Political Sciences, Dr Fotios Pasiouras, University of Surrey & Technical University of Crete, United Kingdom Dr Keith Pilbeam, City University, United Kingdom Dr Maria Psillaki, University of Piraeus, Greece Dr Aris Samitas, University of Aegean, Greece Dr Vasilios Sogiakas, University of Glasgow, United Kingdom Dr Charalambos Spathis, Aristotle University of Thessaloniki, Greece Dr Costas Siriopoulos, Zayed University, College of Business, Abu Dhabi, United Arab Emirates Dr Theodoros Syriopoulos, University of the Aegean School of Business Studies Shipping, Trade & Transport Dpt., Greece Dr Michael Talias, Open University of Cyprus, Cyprus Dr Emmanouil Trachanas, Oxford Brookes University, United Kingdom Prof Efthimios Zervas, Hellenic Open University, Greece Dr Vasileios Zisis, University of Piraeus Department of Business Administration, Greece Dr Constantinos Zopounidis, Technical University of Crete, Greece

Chair of the Conference Dr Augustinos I. Dimitras, Hellenic Open University, Greece

Organizing Commitee Dr Dimitrios Asteriou, Hellenic Open University, Greece Dr Augustinos I. Dimitras, Hellenic Open University, Greece Dr Nikolaos Eriotis, National and Kapodistrian University of Athens, Greece Dr Dimitrios Vasiliou, National and Kapodistrian University of Athens, Greece

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Programme Friday 21-4-2017 03:30 PM – 04:30 PM

Registration

04:30 PM – 06:30 PM

Session F1

06:30 PM – 06:45 PM

Coffee Break

06:45 PM – 08:15 PM

Opening Ceremony

08:30 PM

Gala Dinner

Saturday 22-4-2017

4

09:00 AM – 10:45 AM

Parallel Sessions S01-S04

10:45 AM – 11:00 AM

Coffee Break

11:00 AM – 01:00 PM


01:00 PM – 02:00 PM

Lunch

02:00 PM – 04:00 PM


04:00 PM – 04:15 PM

Coffee Break

04:15 PM – 06:00 PM


SESSION


ROOM

F01 Niki

SESSION CHAIR

ICBE HOU

TITLE - AUTHORS

Kyriaki Kos- The management and utilization of human midou capital in banking sector. Evidence from Greece Christos Pallis, Petros Pallis, Ioanna Chioti The impact of the demographic αging of the greek population on the domestic banking system liquidity Chrysanthi Balomenou, Antonios Liakos Can European Banking Authority’s EU – wide Stress Tests address market anxieties? Dimitris Aloniatis, Evangelos Manouvelos Does board structure matter for bank stability? Xristina Mavrakana, Maria Psillaki The Evolution of Shadow Banking: The case of US Investment Funds Filippos Ioannidis, Kyriaki Kosmidou

S01 Socratis Nikolaos Eriotis

Internal audit and systems of internal audit in Greek banks Kanellos Stulianou Toudas, Ioanna Athanasios Siouziou, Marios Menexiadis Earnings management and audit fees during recession in Eurozone Maria Kyriakou, Augustinos I. Dimitras The impact of internal and external audit on the employees’ performance Andreas G. Koutoupis The role of tax authority audits in corporate tax compliance: empirical evidence from Greece Evangelos Koumanakos, Grigorios Lazos, Theodoros Roumelis

5

SESSION


ROOM

SESSION CHAIR

TITLE - AUTHORS

The influence of earnings management‘s differences in the stickiness of selling general and administrative expenses Dimitris Balios, Nikolaos Eriotis, Vassilios - Christos Naoum, Dimitrios Vasiliou S02 Platon

Athanasios Episcopos

Equity crowdfunding - An innovative instrument for SME financing: Challenges and prospects for Greece Paraskevi Vasileios Boufounou, Theodora Tsaimou Financial & Investment strategies to captivate S&P 500 volatility premium Theodore Syriopoulos, Michael Tsatsaronis, George Alexopoulos How to disgorge less taxed money to investors: Dividends or returns of capital? Apostolos Dasilas, Chris Grose Interaction between risk premium and fear of investors, Fama-French factors and Cahart factor during Dot-Com and Sub-Prime crises : Statistical evidence

Paraskevi Vasileios Boufounou, Antonios Pentsas Long-term market reaction to actual daily share repurchases in Greece Angeliki Drousia, Athanasios Episcopos, George Leledakis

S03 Solon

6

John Filos

Modelling the transmission of financial crises using simulation methods Georgios Antonios Sarantitis, Periklis Gogas, Theophilos Papadimitriou

SESSION


ROOM

SESSION CHAIR

ICBE HOU

TITLE - AUTHORS

Risk management in Greek hospitals: Internal audit contribution in crisis era Andreas Koutoupis, Paraskevi Koufopoulou, Athanassios Vozikis, Stamatios Papadakis, Dimitrios Antonoglou Surgery costs: An empirical approach Ioannis E. Kapantaidakis Application of Geographical Information Systems (GIS) in the management of elderly health matters. Zaxarias Dermatis, Athina Lazakidou Management of Greek public hospitals: Limitations of existing governance and control mechanisms

S04 Omiros Mihail N Diakomi halis

John Filos, Richard Nicolas Lacroix Economic austerity, business environment and human resources: The case of Greece Evangelos I Poutos, Spyros Rizos Research on women engineers career path in construction industry Nadia Konstantina Zamer, Georgios Papadopoulos, Dimitris Robert Stamatiou, Nektaria Dervakou FDI and Human Capital: Gender Educational Effects in European Union Konstantina Louloudi, Constantina Kottaridi 7

ΧΟΡΗΓΟΙ ΣΥΝΕΔΡΙΟΥ:

ΧΟΡΗΓΟΣ ΠΡΟΓΡΑΜΜΑΤΟΣ:

Πανεπιστηµιακά Συγγράµµατα www.propobos.gr

Management of Greek Public Hospitals: Limitations of Existing Governance and Control Mechanisms John Filos 1, Richard-Nicolas LACROIX 2 [email protected] 1

CIA, CFE, PhD, Associate Professor Department of Public Administration, Panteion University, Greece [email protected]

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PhD, National School of Public Administration, Areos 7, 17562 Palaio- Faliro, Greece, (Professor of Business, International Program at Athens Metropolitan College for Queen Margaret University, Edinburg & University of East London, UK). Tel: +30-2109858278 & +306937258071

Abstract The Complexity associated with the Evolving Medical Profession, and the Financial and Legal Challenges of the Current Economic Crisis on the Budgets, and the issues associated with the Humanitarian Refugee Crisis amongst others are some of the Challenges that Modern Greek Public Hospitals Boards and Managers are required to address. While some departments are exemplary in their organization and the quality of their people, the best practices are not systematically applied in Greek Public Hospitals. Based on preliminary literature research and extensive interviews and audits results, we observe limitations to the existing Governance, Processes and Control Mechanisms and on how decisions are made. Besides the obvious of being responsible for a budget and the proper management of the personnel and other resources Management must deliver on performance. To that Effect, we recommend 9 “Outcomes” areas for focus by Management in order to Achieve Patient Centered Quality in HealthCare. The 9 Areas are: 1) Preventing People from Dying Prematurely, 2) Enhancing Quality of Life for people with Long Term Conditions, 3) Help People to recover from episodes of Ill health or following injury, 4) Ensuring people have a positive experience of Care, 5) Treating & Caring for people in a safe and discrimination free environment and protecting them from avoidable harm, 6) Implementing Best Practices and Quality Standards, 7) Utilizing Innovation and Technology to advance and assist the medical profession, 8) Review of Instruments of Measurement and Control in order to Govern according to Best Practices, 9) The issues of Ethics and Cooperation with other Hospitals & Suppliers & the community and other interested parties.

Keywords: Greek Public Hospitals, Governance Evaluation, Audit & Control Mechanisms, Best Practices & Quality Management. JEL Categories: I (Health) and M (Business Administration)

Hellenic Open University Conferences, International Conference on Business & Economics of the Hellenic Open University 2017

John Filos [email protected] 1 CIA, CFE, PhD, Associate Professor Department of Public Administration, Panteion University, Greece ,

Richard-Nicolas LACROIX [email protected] 2 PhD, National School of Public Administration (Professor of Business, International Program at Athens Metropolitan College for Queen Margaret University, Edinburg & University of East London, UK).

Abstract The Complexity associated with the Evolving Medical Profession, and the Financial and Legal Challenges of the Current Economic Crisis on the Budgets, and the issues associated with the Humanitarian Refugee Crisis amongst others are some of the Challenges that Modern Greek Public Hospitals Boards and Managers are required to address. While some departments are exemplary in their organization and the quality of their people, the best practices are not systematically applied in Greek Public Hospitals. Based on preliminary literature research and extensive interviews and audits results, we observe limitations to the existing Governance, Processes and Control Mechanisms and on how decisions are made. Besides the obvious of being responsible for a budget and the proper management of the personnel and other resources Management must deliver on performance. To that Effect, we recommend 9 “Outcomes” areas for focus by Management in order to Achieve Patient Centered Quality in HealthCare.

Governance Definition

Literature Search Criteria Two databases were searched. [Medline: http://www.nlm.nih.gov/bsd/pmresources.html] is considered a comprehensive source of academic journal articles related to all aspects of healthcare, and [King’s Fund library in the U.K.: http://www.kingsfund.org.uk/library] holds a broad selection of internationally published grey literature as well as academic articles. The search terms and strategy for Medline is detailed at the end of our paper. it was designed to capture articles which examined aspects of the relationship between performance measurement and the quality of healthcare. The resulting references from both databases were imported into a reference management program, Endnote X5, and their abstracts screened. Any articles not meeting the following inclusion criteria were excluded. The full texts of those remaining were included in the review. Inclusion criteria: • Any article whose focus is on the relationship between performance measurement and some aspect(s) of the quality of health care [these articles are labelled ‘central relevance’ in the search results; • OR any article whose focus is on the development or operation of a national- or regional- level performance measurement regime, and addresses the link between that regime and quality improvement [these articles are labelled ‘useful background’ in the search results

Literature Search findings (1 of 3) The review found that although there is a substantial literature dealing with the design, properties and scientific soundness of individual indicators, there is much less consideration of how indicators are actually used in practice and of the impact they may have on behaviour of health professionals, or on the quality of care. Most if not all health systems in the developed world incorporate some form of health performance measurement to gauge the amount of activity being completed in return for investment made by funding bodies, and more recently towards improving patient experiences and outcomes The quest for a single ‘composite’ indicator has largely been abandoned in favour of multidimensional frameworks. Common domains are: efficiency, effectiveness and equity, augmented by quality of care measures: patient safety, timeliness of care and patientcentredness. Indicator sets commonly contain a combination of structure, process and outcome assessments A key theme in the literature is that performance indicators are not an end in themselves. The main debate is whether they should be used for accountability or for quality improvement. Internationally, there is a split between countries who emphasise public reporting and accountability (UK) and those that use results for non-publicised feedback to organisations to stimulate improvement (Germany’s voluntary reporting scheme).

Literature Search findings (2 of 3) The review found that authors recommend indicators for formative improvement rather than summative judgement.

The link between performance measurement and quality improvement , the extent to which this is true is disputed and under researched. There are four categories of barriers to the link between performance measurement and improved quality of care: 1) problems intrinsic to the indicator (e.g. lack of scientific validity/reliability), 2) problems with collected data (e.g. absence of a unique patient identifier that prevents database linkages, poor standardised coding), 3) problems with the use and interpretation of the data (e.g. alleged under- and over-reporting, selecting certain measures to represent a whole organisation’s performance), 4) the confounding influence of organisational and contextual factors (e.g. poor culture of improvement, professional resistance to complying). While damage to an organisation can result from public reporting of performance indicators without due attention to the required caveats, organisations can use these same caveats as excuses to avoid internal action (e.g. ‘coding errors’ were used to vindicate ignoring poor results at Stafford Hospital in England)

Literature Search findings (3 of 3) The review found that for the Evidence of impact on the quality of care: Much has been written about the negative consequences of the ‘command and control,’ target-driven systems of performance monitoring where receiving rewards (whether financial, good reputation or earned autonomy) is made contingent upon reaching targets. It is argued that these systems encourage perverse consequences including: ‘target myopia’ where clinical priorities can be distorted, driving a culture of bullying of under-performing managers and clinicians, a stigmatisation of poorly performing organisations and at worst, active manipulation of the data. public reporting of performance data to improve the UK quality of care concluded: ‘we cannot draw any firm conclusions There appears to be a low rate of use of publically reported performance data by consumers in decision-making in healthcare and a general lack of interest in published performance data by the public and politicians

Literature Search Canadian Health Indicator Framework Canadian Health Indicator Framework:

Literature Search UK Framework Relationship between NHS Next Stage Review, High Quality Care for All and NHS Outcomes Framework (the first 5 of the 9 recommendations of our paper are based on this framework)

Governance European Results 2016 The Euro Health Consumer Index classified Health Governance countries for 2016: 1) the best in Green 2) the average in Yellow 3) the worst in Red. Greece’s poor position can be attributed to: 1) budget cuts while facing economic & refugee crisis 2) Average organization & less than optimal practices 3) often less than qualified boards 4) not enought patient focused 5) problem with audit processes & transparency of results 6)Ethics with supplies & other areas 7) Insufficient relience on Technology

Governance European Results 2016 Greece was reporting a dramatic decline in healthcare spend per capita: down 28 % between 2009 and 2011, but a 1% increase in 2012! This is a totally unique number for Europe; also in countries which are recognized as having been hit by the financial crisis, such as Portugal, Ireland, Spain, Italy, Estonia, Latvia, Lithuania etc, no other country has reported a more severe decrease in healthcare spend than a temporary setback in the order of < 10 % (see Appendix 2). There is probably a certain risk that the 28% decrease is as accurate as the budget numbers, which got Greece into the Euro. Greece has markedly changed its traditional habit as eager and early adopter of novel pharmaceuticals to become much more restrictive. However, the graph below shows that as late as 2012, Greece still had the 3rd highest per capita consumption of pharmaceuticals in Europe, counted in monetary value! Part of the explanation for this is unwillingness to accept generic drugs. It would seem that pharmacists (and doctors?) are not keen on communicating to patients that generics are equal to the branded drugs. What has partially changed in Greece is the readiness to adopt new drugs. As Indicator 6.5 (new arthritis medication) shows, Greece has in some cases radically changed its previous generous attitude to the introduction of novel, expensive pharmaceuticals. Also, the position of Greece in the drug expenses league has dropped from #3 in 2012, to #11 in 2014.

Governance European Results 2016

Figure 1.3.28a. Greek pharma expenditure is possibly affected by the fact, that Greece (and Italy) are the two countries in Europe, where the levels of corruption exceed what could be expected against the poverty level. Source: www.euractiv.com/section/health-consumers/news/novartis-underscrutiny-for-alleged-pharma-scandal-in-greece/?nl_ref=28487074


Figure 1.3.28b.

Corruption scores vs. GDP/capita. On the corruption scale, a score of 100 denotes a corruption-free country; the lower the score, the more severe the corruption. There is a quite close correlation (R = 90%) between poverty and corruption. Deviating negatively (i.e. more corrupt than should be expected) are Italy, Greece and Ireland. Very honest, in relation to their economic means, are Estonia and Finland. The three rich countries LUX, CH and NO have been left out – their GDP/capita is 50 – 100% higher than that of any other country.


Figure 1.3.28b. Physicians per 100 000 population (broad bars) and Number of doctor appointments per capita (yellow narrow bars). Greece leads Europe by a wide margin in the number of doctors per capita (below), and also has the highest number of pharmacists per capita. Still the picture of Greek healthcare, painted by the patient organisation responses, does not at all indicate any sort of healthy competition to provide superior healthcare services. It would seem almost supernatural that Greece can keep having the large number of doctors and pharmacists, unless these have taken very substantial reduction of income. It deserves to be mentioned that the indicators on Outcomes (treatment results) do not show a worsening of results for Greece.

Governance Best Practices In addition to litterature review & interviews of hospital Board members We reviewed prior researchand Benchmark from these two Reports:

Findings from 1st report

GDP on health and life expectancy, 2005-06. Source OECD 2008. Greece is ranking below average.

Findings 1st Report: Advantages & Disadvantages of Process versus Outcome Measures The main measures are summarized in the folllowing table:

Findings from 2nd Benchmark List of Research Benchmark Reviewed:

2 Benchmark Hospital Compare nd

Hospital Compare is a large public database that uses nationally standardized performance measures to compare over 4000 US hospitals that submitted data relating to the quality of care provided in their institutions and allowed it to be made public. The following and reported are: • Process of care • Outcome of care • Patients hospital experience • Medicare payment and volume This database is the result of collaboration between both public and private stakeholders. Scoring System Hospital Compare doesn’t rank hospitals, rather it reports the percentage of patients for which a given indicator was performed/completed (i.e. 98% of the time patient received prophylactic antibiotics prior to surgery). Comparative graphs are also available in which the nationwide and state averages for all hospitals reporting that indicator are displayed alongside the score for the specific hospital(s) chosen. Website: www.hospitalcompare.hhs.gov

2nd Benchmark Healthinsight HealthInsight National Rankings for Hospitals: HealthInsight is a private not-for-profit organization that conducts various health performance rakings including national rankings for hospitals, home health agencies and nursing homes in an effort to improve healthcare systems in Nevada and Utah. It uses publicly reported data from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website to conduct the hospital rankings. Healthinsight measures hospital performance by examining the process of care measures for acute myocardial infarction, heart failure, pneumonia and surgical infection prevention as set out by CMS. Scoring system Hospitals are ranked based on their overall success rate for performing the process of care measures for the above mentioned conditions; rankings are converted and reported as percentiles. Website: www.healthinsight.org

2nd Benchmark Leapfrog Leapfrog Group: This initiative is comprised of private and public purchasers of health care that seek to leverage their purchasing power to improve the quality of services provided by health care institutions. Unlike Hospital Compare, here hospital performance is measured by using structural indicators instead of clinical ones to produce a composite index of hospital performance to measure hospital per • Computerized physician order entry (CPOE) system • ICU staffing • High risk treatments (evidence based hospital referral) • Leapfrog safe practice scores (27 procedures in place to reduce preventable medical mistakes) Leapfrog invites hospitals from 39 US regions to participate in their survey Scoring system Leapfrog scoring algorithm uses ratings which fall into five categories. The rating system is based on how far the health care institution has come with regards to meeting the criteria/standards set out by Leapfrog. Website: www.leapfroggroup.org • Declined to respond • Willing to report • Some Progress • Substantial Progress • Fully Meets Standards

2nd Benchmark MMTC Michigan Manufacturing Technology Center (MMTC): This benchmarking system uses 23 metrics to measure a hospital’s performance. the following five categories: • Business (3) • Productivity (5) • Asset utilization (5) • Throughput (6) • Clinical outcomes (4) Data on hospital practices are also collected in the areas of clinical practices, cost profile and patient, safety policies. Scoring System MMTC reports a hospital’s relative performance on each measure within a comparison group of similar hospitals; hospital percentile rankings range Website: http://www.performancebenchmarking.org/hospital.aspx

2nd Benchmark US News & World Report US News & World Report: http://health.usnews.com/sections/health/best-hospitals Every year the US News & World Report releases a list of the best hospitals in the United States. It ranks hospitals based on 16 specialty areas (e.g., oncology, cardiology) are based on nominations by specialists that Benchmarking Hospital Performance These metrics fall into from 0 (worst in the group) to 100 (best in the group). , 12 of which are based on hard data while the remaining four were surveyed. To be considered you need: 1) Be a member of the Council of Teaching Hospitals and Health Systems 2) Be affiliated with a medical school 3) Have at least a certain number of key technologies (image-guided radiation therapy, full filed digital mammography) Scoring System A score from 0 – 100 is assigned based on three factors that are given equal weight: 1. Reputation (random sample of 200 physicians from ABMS database) 2. Death rate (mortality index) 3. Care-related factors (nursing staff, technology, volume, patient services) Hospitals with the 50 highest scores are subsequently ranked.

2nd Benchmark Thomson & Reuters Thomson & Reuters Top 100 Hospitals Program: http://www.100tophospitals.com The primary goal of this program is to objectively identify US hospitals that have the best organization wide performance and make this data publically available. The performance of all members of the hospital is measured including that of the Board, executives and health care professionals. The organization-wide performance is then compared against national benchmarks. Hospitals are classified into 5 ‘peer’ groups based on bed size and teaching status: 1Major teaching hospitals 2Teaching hospitals 3Large community hospitals 4Medium community hospitals 5Small community hospitals Scoring System Statistical analyses of publically available data sources scored based on a set of weighted performance measures spanning the following 4 areas: • Clinical excellence • Operating efficiency • Financial health • Responsiveness to the community.

2nd Benchmark Health Consumer Powerhouse Health Consumer Powerhouse: Health Consumer Powerhouse produces an annual index comparing performance of health care systems of the European Union in various areas in an attempt to strengthen the position of the healthcare consumer in 5 sub-disciplines:

Scoring System Each sub-discipline is weighted as follows: Furthermore, each indicator has a maximum possible score of 3; scores are colour coded as follows: green = 3 pts , amber = 2 pts, red/not available = 1 pt. Scores for each subdiscipline are calculated as a percentage of the maximum possible score and multiplied by the weight coefficients and added up to make the final country score. These Percentages are then multiplied by 133, and rounded to a 1000 indicating “the perfect healthcare system”. http://www.healthpowerhouse.com/

Governance & Economic Crisis According to in Greece https://www.theguardian.com/world/2017/jan/01/patients-dying-greece-public-health-m eltdown article of 2017: 'Patients who should live are dying': Greece's public health meltdown Seven years of austerity have seen hospitals become ‘danger zones’, doctors say, with many fearing worse is to come. Figures released by the European Centre for Disease Prevention and Control recently revealed that about 10% of patients in Greece were at risk of developing potentially fatal hospital infections, with an estimated 3,000 deaths attributed to them. Frequently, patients are placed on beds that have not been disinfected. Staff are so overworked they don’t have time to wash their hands and often there is no antiseptic soap anyway.” No other sector has been affected to the same extent by Greece’s economic crisis. Bloated, profligate and corrupt, for many healthcare was indicative of all that was wrong with the country and, as such, badly in need of reform. By 2014, public expenditure had fallen to 4.7% of GDP, from a pre-crisis high of 9.9%. More than 25,000 staff have been laid off, with supplies so scarce that hospitals often run out of medicines, gloves, gauze and sheets. We don’t have nephrologists, for example, because there are no prospects for specialists, either in or out of the system [in private practice].there has been a massive exodus of doctors abroad, mostly to Germany and the UK, as a result of lack of opportunity.

Governance Legislation in Greece According to /www2.deloitte.com in addition to The OECD Principles of Corporate Governance (international benchmark for corporate governance worldwide) & The Hellenic Corporate Governance Code (drafted at the initiative of the Hellenic Federation of Enterprises (SEV) http://www.helex.gr/ese) , the principal Governance legislation for hospitals is regulated by laws: Law 3016/2002, “On corporate governance, board remuneration and other issues”, as in force, sets the main requirements for the Corporate Governance of listed companies. Indicatively it includes requirements for the participation of non-executive directors and independent non-executive directors on the Boards of Greek listed companies, and the establishment of an internal audit function. Law 3873/2010, as in force refers to the requirement for disclosure of an annual corporate governance statement as a specific section of the annual report. Law 3693/2008, as in force refers to the requirement for the establishment of an audit committee. Law 2190/1920, as in force includes core governance rules for Societes Anonymes.

Technology always a step ahead of Patient Relationship & Expectations

What Governance Models Should Cover

Governance Seen As Vertical Functions

Governance Seen As Processes

Governance Seen As A Chain of Command

How A Governance Model Can Be Deployed

Conclusion - Best Practice Governance should continually improve on: The 9 Areas are: 1) Preventing People from Dying Prematurely, 2) Enhancing Quality of Life for people with Long Term Conditions, 3) Help People to recover from episodes of Ill health or following injury, 4) Ensuring people have a positive experience of Care, 5) Treating & Caring for people in a safe and discrimination free environment and protecting them from avoidable harm, 6) Implementing Best Practices and Quality Standards, 7) Utilizing Innovation and Technology to advance and assist the medical profession, 8) Review of Instruments of Measurement and Control in order to Govern according to Best Practices, 9) The issues of Ethics and Cooperation with other Hospitals & Suppliers & the community and other interested parties. Keywords: Greek Public Hospitals, Governance Evaluation, Audit & Control Mechanisms, Best Practices & Quality Management. JEL Categories: I (Health) and M (Business Administration)

Indicative References 1) Pirozek, Petr et al. “Corporate governance in Czech hospitals after the transformation”, Health Policy , 2015; Volume 119 , Issue 8 , 1086 - 1095 2) Saltman, R.B., Duran, A. Innovative strategies in governing public hospitals. Eurohealth. 2013;19:3–7 3) Bennington, L. Review of the corporate and healthcare governance literature. Journal of Management & Organization. 2010;16:314–333 4) Steane, P.D., Christie, M. Non-profit boards in Australia: a distinctive governance approach. Corporate Governance. 2001;9:48–58 5) Saltman, R.B., Duran, A., DuBois, H.F.W. Governing public hospitals: reform strategies and the movement towards institutional autonomy. European Observatory on Health Systems and Policies, Brussels; 2011 6) OECD. Principles of corporate governance. OECD Publication Service, Paris; 2004 7) Shaw, C. How can hospital performance be measured and monitored. Regional Office for Europe W.H.O., Copenhag; 2003 8) Tchouaket, E.N., Lamarche, P.A., Goulet, L., Contandriopoulos, A.P. Health care system performance of 27 OECD countries. International Journal of Health Planning and Management. 2012;27:104–129 9) Eeckloo, K., Delesie, L., Vleugels, A. Where is the pilot? The changing shapes of governance in the European hospital sector. The Journal of the Royal Society for the Promotion of Health. 2007;127:78–86 10) Pettersen, Inger Johanne et al. Governance and the functions of boards: An empirical study of hospital boards in Norway, Health Policy , 2012; Volume 107 , Issue 2 , 269 - 275 11) Søgaard, Rikke et al. Incentivising effort in governance of public hospitals: Development of a delegation-based alternative to activity-based remuneration, 2015; Health Policy , Volume 119 , Issue 8 , 1076 - 1085